| Vol.
I, No. 4 |
January
Thaw |
Jan.
19th, 2001 |
Health & Medicine
Vital Signs:
Heart of the Matter
Heart disease in its many forms is, of
course, one of the greatest health problems in the
nation -- both for individuals & their families,
and in the context of public health. Among
recent news in the world of medicine about heart
disease & treatments ...
-
The failure to deal with heart
failure prevention & education ...
In the previous issue of The
New England Journal of Medicine, an
editorial -- entitled "Diastolic Heart
Failure -- No Time to Relax," by Ramachandran
S. Vasan, M.D., of the Framingham Heart Study
& Emelia J. Benjamin, M.D., of the Boston
University School of Medicine -- cited several
sources that highlighted what the authors referred
to as "the the persistent gap that must
be bridged between clinical practice and national
guidelines for the prevention and control of
hypertension." ... While the
article focused on diastolic heart failure, among
their citations were several stats on heart
failure & hypertension in general,
viz.:
.
-
There are 4.6 million people
in the United States with heart failure today
...
-
... 550,000 new cases are
being reported annually ...
-
... only 29 percent of
patients with hypertension in the United
States are aware of their condition and are
adequately treated ... (N Engl J Med 2001;344:
Full
Text.)
.
-
When can heart disease set
in? ...
Most of us are aware that heart disease can
readily strike those under 60, and, though more
rarely, even those under 50. However, in a
recent Case Report in The
Lancet, the British medical journal, a
group of doctors at Stanford University Medical
Center wrote about a woman -- "without
coronary risk factors" -- who was
having chest pains upon exertion, as well as
difficulty breathing. in January, 1999.
The Case Report was entitled "A 25-year-old
with severe coronary artery disease." (Lancet
2001; 357: 116.)
.
-
Treatment worse than
disease? ...
Only yesterday, Reuters
Health reported that doctors at the
Cleveland Clinic called for a moratorium on
one of the preferred emerging treatments for
coronary artery disease -- the use of
anti-platelet agents know as oral glycoprotein
IIb/IIIa antagonists. According to a
researchers at the clinic, "the use of
oral formulations of these agents actually
increases mortality by an average of
31%." However, the increased
mortality was not due to subsequent MI's
{heart attacks}, and the researchers appear to
be at least somewhat baffled by the underlying
cause. (Article.)
... An earlier study, referred to in an
editorial in The
New England Journal of Medicine, had
raised at least some questions when, during a
clinical trial of another brand of
glycoprotein IIb/IIIa antagonist -- tirofiban
-- the study had to be "stopped
prematurely in the tirofiban-alone group
because of excess mortality at seven
days" when compared to the patients who
were also receiving heparin, long the
treatment mechanism for reducing
clotting. In that study, all patients
were also receiving aspirin. (N Engl J
Med 1998;338: Full
Text.)
Perhaps more surprising,
almost a year ago, The
Lancet published the results of a
clinical trial which showed -- with solid
confidence -- that aspirin was as effective in
lowering the incidence of subsequent coronary
events within 90 days after an acute episode
-- the period of greatest risk.
Moreover, at least in comparison with the
high-dose version of platelet antagonist,
aspirin actually produced considerably less
dose-related bleeding, as well. The
latter article, entitled "Comparison of
sibrafiban with aspirin for prevention of
cardiovascular events after acute coronary
syndromes," studied nearly 10,000
patients. [Sibrafiban is one form of the
platelet antagonist.] (Lancet
2000 Jan 29; 355(9201): 337-45. Full
Text. Requires free registration.)
.
.
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